| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 01C0001010 | (X3) Date Survey Completed 09/18/2019 |
| Name of Provider or Supplier The Southern Alabama Surgery Center, Llc | Street Address, City, State 2800 Ross Clark Circle, Suite 3, Dothan, AL | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| K0351 | Sprinkler System - Installation CFR(s): NFPA 101 Sprinkler System - Installation Sprinkler systems (if installed) are installed per NFPA 13. Where more than two sprinklers are installed in a single area for protection, waterflow devices shall be provided to sound the building fire alarm system or to notify a constantly attended location such as a PBX, security office, or emergency room. 20.3.5.1, 20.3.5.2, 21.3.5.1, 21.3.5.2, 9.7.1.2, 9.7, NFPA 13 This STANDARD is not met as evidenced by: . Based on observation and interview, the facility failed to maintain the automatic sprinkler system per the requirements of: 2012 NFPA 101, 9.7.1.2 2010 NFPA 13, 6.2.9.6, 8.6.4.1.1.1, 8.5.4.2, and 8.1.1(3) Findings include: On 09/17/2019, during a tour of the facility from 10:30 am to 4:30 pm, the surveyor observed the following: 1. The sprinkler cabinet was without a sprinkler wrench 2. An approximately 1' x 2' ceiling tile was missing in the Telecom Room off of Hall 8 on the east side of the facility 3. The triangular shaped Counseling Room in the corner of the G.I. Hall in the new section did not have automatic sprinkler coverage A member of the maintenance staff was present when this deficiency was identified. . |